Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws

Abstract

Objective: To analyze the usage of floor-mounted robot in minimally invasive lumbar fusion.Methods: Patients who underwent minimally invasive lumbar fusion for degenerative pathology using floor-mounted robot (ExcelsiusGPS) were included. Pedicle screw accuracy, proximal level violation rate, pedicle screw size, screw-related complications, and robot abandonment rate were analyzed.Results: Two hundred twenty-nine patients were included. Most surgeries were primary single-level fusion. Sixty-five percent of surgeries had intraoperative computed tomography (CT) workflow, 35% had preoperative CT workflow. Sixty-six percent were transforaminal lumbar interbody fusion, 16% were lateral, 8% were anterior, and 10% were a combined approach. A total of 1,050 screws were placed with robotic assistance (85% in prone position, 15% in lateral position). Postoperative CT scan was available for 80 patients (419 screws). Overall pedicle screw accuracy rate was 96.4% (prone, 96.7%; lateral, 94.2%; primary, 96.7%; revision, 95.3%). Overall poor screw placement rate was 2.8% (prone, 2.7%; lateral, 3.8%; primary, 2.7%; revision, 3.5%). Overall proximal facet and endplate violation rates were 0.4% and 0.9%. Average diameter and length of pedicle screws were 7.1 mm and 47.7 mm. Screw revision had to be done for 1 screw (0.1%). Use of the robot had to be aborted in 2 cases (0.8%).Conclusion: Usage of floor-mounted robotics for the placement of lumbar pedicle screws leads to excellent accuracy, large screw size, and negligible screw-related complications. It does so for screw placement in prone/lateral position and primary/revision surgery alike with negligible robot abandonment rates.

Image-Guided Navigation in Spine Surgery: From Historical Developments to Future Perspectives

“…Even with the limitations associated with stand-alone robotic assistance, studies have reported favorable results regarding the accuracy of pedicle screw insertions in the range of 94.5% and 99% [37,40,[50][51][52]. One study investigating floormounted robotic pedicle screw placement found pedicle screw accuracy in 229 patients with 1050 screws to be 96.4% [53]. As software programs and available technology continue to advance, surgeons will adapt.…”

Advancing the Adoption of Robot-Assisted Surgery as the Routine Minimally Invasive Approach in Spinal Procedures: Commentary on “Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws”

“…One notable advancement in this area is the utilization of robot-assisted (RA) techniques in spinal surgery, which provide enhanced safety, accuracy, and minimal invasion compared to conventional surgical techniques. 1 Shahi et al 2 investigated the application of floor-mounted robot (ExcelsiusGPS, Globus Medical, Inc., Audubon, PA, USA) in minimally invasive lumbar fusion. They included a large sample size of 229 patients with 1,050 pedicle screws, and found that the accuracy of pedicle screw placement in RA methods was 96.4%, and the proximal facet and proximal endplate violation rates were 0.4% and 0.9%, respectively, indicating that RA techniques contributed to excellent accuracy, large screw size, and negligible screw-related complications.…”